Cardiac rhythm devices in the pediatric population: Utilization and complications

Background: Cardiac rhythm devices are important in the management of pediatric patients with rhythm abnormalities, although factors driving utilization are poorly understood. Objective: This study sought to evaluate utilization trends, complication rates, and cost associated with device implantation in the pediatric population. Methods: Device implantation was analyzed using the Kids' Inpatient Database from 1997 to 2006. The type of device implantation, patient demographics, hospital characteristics, acute in-hospital complications, cost, and length of stay (LOS) were analyzed. χ² tests were used to test association between categorical variables, and logistic regression analysis was performed to evaluate risk factors associated with complications. Results: There were 5788 hospitalizations with device implantations. Although there was a significant increase in defibrillator implantation, there was no significant increase in the number of pacemaker implantations over this time period. Patient- and device-related complications were relatively common in all device cohorts (pacemaker 11.2%, 7.2%; defibrillator 5.9%, 11.5%; and biventricular device 19.4%, 26.7%). Type of complication was dependent on device type. Increased risk of complication was evident in the pacemaker cohort, patients with congenital heart disease, cardiomyopathy, previous cardiac arrest, and other heart operations. Patient-related complications increased cost and LOS regardless of patient or procedural characteristics. Device implantation in patients <5 years old was associated with increased LOS and cost but was not associated with increased risk of complication. Conclusion: Device utilization in pediatrics is increasing due to escalating defibrillator implantation and biventricular pacing. Cost and LOS are significantly increased by patient complications. Reduction in these complications would improve patient care and lower medical costs.